Strategies to reduce nosocomial infections are traditionally based on handwashing with antiseptic soap, but fewer than 50 percent of health care professionals comply with standard recommendations. Handrubbing with alcohol-based antiseptic appears to be the best method of increasing hygiene compliance, but many health professionals have limited confidence in its efficacy. Girou and colleagues compared the effectiveness of handrubbing with an alcohol-based solution to handwashing with antiseptic soap in intensive care units of a French university hospital.

Nurses arriving for morning shifts were randomly assigned to standard handwashing with antiseptic soap or handrubbing with an alcohol-based solution. All participants had been instructed in both techniques as part of staff training, and printed protocols were available in each unit. Patient care activities were monitored daily for two to three hours until the participant had performed five selected activities, each of which required hand hygiene before and after the procedure. Imprints were taken of participants' fingertips and palms before and one minute after the procedure. The number of bacterial colonies recovered after 48 hours of incubation was used to measure contamination. The researchers looked specifically for pathologic organisms, especially methicillin-resistant Staphylococcus aureus.

Of the 23 participants, 12 were randomized to handrubbing and 11 to handwashing. The two groups were comparable and performed similar activities (i.e., 59 procedures in the handrubbing group and 55 in the handwashing group). The median duration of each episode of handrubbing or handwashing was only 30 seconds. In both groups, the bacterial counts were lower after hand hygiene. The median reduction in bacterial contamination was significantly lower after handrubbing (83 percent) than after handwashing (58 percent).

The authors conclude that handrubbing with an alcohol-based solution is significantly more efficient in reducing hand contamination than conventional washing with antiseptic soap. In the study, health professionals spent inadequate time in handwashing.

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